Survivor goes undercover in Tijuana cancer clinics
Filed under: Health journalism, Hot Health Headline
Reporting for Al Jazeera English’s People & Power, Sarah Macdonald tells how her own battle with breast cancer led her to shave her head, hide a camera and go undercover to investigate south-of-the-border clinics touting alternative cancer therapies.
The thriving sub-industry of alternative Tijuana cancer clinics relies primarily on palliative care licenses to operate, a end-of-life-care-focused designation that seems somewhat sinister when it’s hidden behind promises of miracle cures. In looking beyond those promises, MacDonald’s investigation finds an interesting mix of chicanery and genuine good intentions, but ends on a familiar, cautionary note.
I have been fortunate in that I have successfully emerged from my own treatment for breast cancer, so I completely understand the desperation that people will feel when they are told their condition is terminal. It is a death sentence. I understand why many patients or their families will begin to scour the internet in search of a cure and will seize on anything that offers hope. However, as our investigation has shown, at least some of the Tijuana clinics are offering nothing but false hope. There is little or no evidence to support their claims that their strange therapies actually work and there is plenty of evidence that vulnerable people have parted with large sums of money for no reason.
Critically evaluate, report on cell phone/cancer link
Filed under: Health journalism, Health policy, Hot Health Headline
Courtesy of the International Agency for Research on Cancer’s press release and the storm of advance coverage it has spawned, you’re probably already braced for Lancet’s imminent publication of the IARC’s report classifying “radiofrequency electromagnetic fields” as “possibly carcinogenic to humans,” otherwise known as the cell phone/cancer link.
While you’re waiting, it’s worth taking a few minutes to put yourself in position to critically evaluate the study. The six-page press release is a decent place to start, but as Dr. Len Lichtenfeld, blogger and deputy chief medical officer for the national office of the American Cancer Society, reminds us, IARC is a respected source, but the science they’re reviewing is tricky and, at this point, it’s just a press release.
For background on the scientific debate, see Lichtenfeld’s commentary and Eliza Barclay’s post on Shots, NPR’s health blog.
If you don’t have time for the full press release right now, I have pasted what I consider the two must-read paragraphs below. The first summarizes what the working group found upon reviewing established science, while the second explains exactly how the scientists are currently classifying the possible link between cell phones and cancer. Between the two of them, you get a quick snapshot of the study and its implications.
Results
The evidence was reviewed critically, and overall evaluated as being limited among users of wireless telephones for glioma and acoustic neuroma, and inadequate to draw conclusions for other types of cancers. The evidence from the occupational and environmental exposures mentioned above was similarly judged inadequate. The Working Group did not quantitate the risk; however, one study of past cell phone use (up to the year 2004), showed a 40% increased risk for gliomas in the highest category of heavy users (reported average: 30 minutes per day over a 10‐year period).
Group 2B: The agent is possibly carcinogenic to humans.
This category is used for agents for which there is limited evidence of carcinogenicity in humans and less than sufficient evidence of carcinogenicity in experimental animals. It may also be used when there is inadequate evidence of carcinogenicity in humans but there is sufficient evidence of carcinogenicity in experimental animals. In some instances, an agent for which there is inadequate evidence of carcinogenicity in humans and less than sufficient evidence of carcinogenicity in experimental animals together with supporting evidence from mechanistic and other relevant data may be placed in this group. An agent may be classified in this category solely on the basis of strong evidence from mechanistic and other relevant data.
For more perspective on what a 2B classification really means, see Katherine Harmon’s post on the Scientific American editors’ blog. Her key point is that “The May 31 announcement, however, doesn’t imply that cell phones cause cancer. It suggests that there are still enough unknowns not to rule out long-term health effects of the devices.”
Merrill Goozner expects the evidence to be murky and he concludes that IARC’s tenuous conclusion will be fully justified but also largely ignored by the public. He also points us to Lou Slesin’s Microwave News for solid reporting on the conflicts of interest surrounding the issue.
Finally, once the science is published and it’s time to file stories, be sure to refer to AHCJ’s guide to covering medical studies (membership required), where you’ll find all the tips and reminders necessary to ensure you’ve covered all the bases on this high-profile story.
Online guide focuses on covering medical studies
Reporters are inundated with lures to cover the latest medical study or scientific conference paper. And there are some significant milestones being reached in medical research. But, more often, the information reaching the public is way too preliminary or even misleading, say those behind a new AHCJ reporting guide on covering health studies.
The guide will help journalists analyze and write about health and medical research studies. It offers advice on recognizing and reporting the problems, limitations and backstory of a study, as well as publication biases in medical journals and it includes 10 questions you should answer to produce a meaningful and appropriately skeptical report. This guide, supported by the Robert Wood Johnson Foundation, will be a road map to help you do a better job of explaining research results for your audience.
Research into ‘chemobrain’ making progress
In the most recent issue of Cure, AHCJ member Elaine Schattner, M.D., examines “chemobrain,” a term used to describe cognitive changes that some patients experience during and after a chemotherapy regimen.
Schattner interviewed medical professionals and cancer survivors to shed light on “chemobrain,” which isn’t included in the Diagnostic and Statistical Manual of Mental Disorders. She cites several studies that link cognitive decline to both chemo and hormone therapies in men and women.
It took decades for research on chemobrain to gain traction, says Tim Ahles, PhD, a behavioral psychologist who leads the neurocognitive research lab at Memorial Sloan-Kettering Cancer Center. Ahles says investigators have had a tough time applying science to cancer patients with such a range of cognitive complaints and diverse diagnoses. In addition, patients often suffer from accompanying problems, such as anemia, pain, depression and other illnesses that can affect brain function.
Another doctor who has been studying the condition acknowledges that patient advocacy has helped move the research forward. But research is hindered by variations in the forms, doses and regimens of chemo, as well as “the fact that the condition lacks a precise definition and has a variety of symptoms that are subjective and vague.”
Members’ investigations prompt bills in Wash.
Filed under: Government, Health journalism, Health policy, Member news, Nursing, Pharmaceuticals
Three health-related bills moving through the Washington legislature came about as a result of articles reported by AHCJ members at The Seattle Times and InvestigateWest.
One bill is part of a “proposed overhaul of laws on long-term care of elderly adults” that was prompted by “Seniors for Sale,” a series by Seattle Times reporter and AHCJ member Mike Berens that detailed problems in the state’s adult family homes.
Another bill, unanimously approved by the state senate, will push a state agency to create standards on how to handle chemotherapy drugs. It was prompted by reporting from AHCJ member Carol Smith of InvestigateWest, a nonprofit journalism organization, that revealed that nurses who handle those drugs are exposed to health problems.
A related bill, intended to identify potential links between occupational exposures and cancer outcomes, also was unanimously approved by the senate. It would “require that a cancer patient’s occupation be reported to the registry, and that if the patient is retired, the patient’s primary occupation before retirement be reported,” InvestigateWest reports.
2011 brings changes to The Cancer Letter
AHCJ member Kirsten Goldberg is stepping down as editor and publisher of The Cancer Letter, a position she’s held since taking her father’s place at the helm 20 years ago. Goldberg is headed to the American Society of Clinical Oncology, where she will become, according to the release, “a senior program manager in the Communications and Patient Information Department, focusing on policy communications.”
She has been replaced by Paul Goldberg, a fellow AHCJ member who first worked with the publication in 1986. He has worked there full time since 1992.
The Cancer Letter is an independent publication that covers oncology, drug development and cancer research. It was founded by Jerry Boyd in 1973 and has remained in the family.
Pfizer-funded workshop raises questions of ethics
Filed under: Conflicts of interest, Health journalism, Pharmaceuticals
Christopher Weaver, in a piece from Kaiser Health News and NPR, writes about a Pfizer-funded seminar for journalists. To attend the annual seminar about cancer, hosted by the National Press Foundation, 15 journalists get an all-expenses-paid trip to Washington, D.C.
Health care journalists, including HealthNewsReview.org’s Gary Schwitzer and AHCJ president Charles Ornstein, say reporters need to be careful and avoid even the appearance of a conflict of interest.
Foundation president Bob Myers says the pharmaceutical company does not have input on the meeting and an attendee of last year’s meeting, AHCJ member Joy Robertson, says she doesn’t remember Pfizer ever being mentioned at the event.
Commenters on the KHN/NPR include AHCJ members Ornstein; Andrew Holtz, M.P.H. (also a board member); Elaine Schattner, M.D.; and Schwitzer. Schattner, a licensed, non-practicing physician and medical educator, says “This is precisely how Pfizer and other companies try to influence physicians who, in their sometimes-arrogance, tend to think they’re “above” subtle persuasion. Are journalists any better?”
Journalist Merrill Goozner also has written about the seminar and says that that Pfizer has dictated the overall agenda:
Pfizer didn’t make an unrestricted grant to a journalism training organization. The money is being spent to train journalists in how to cover cancer.
Goozner points out, as does Holtz in his comment on the NPR/KHN piece, that “journalism spends less on training than almost any other profession” and that journalists have few opportunities to get out of the newsroom for professional education.
Covering Health wrote about this seminar and this issue last year. It’s worth noting, as we did then, that the Association of Health Care Journalists and the Center for Excellence in Health Care Journalism seek to minimize the possibility and appearance of inappropriate influence from outside parties. Pharmaceutical companies, insurance companies and medical device makers are examples of organizations with with AHCJ will not partner. Read AHCJ’s complete fundraising policies.
AHCJ’s Statement of Principles, which identifies challenges that health care reporters face and suggests how to meet those challenges, addresses the topic:
- Refuse gifts, favors, and special treatment. Refuse meals from drug companies and device manufacturers and refuse to accept unsolicited product samples sent in the mail.
- Weigh the potential benefits involved in accepting fees, honoraria, free travel, paid expenses from organizers of conferences or events against the desire to preserve our credibility with the audience and the need to avoid even the appearance of a conflict of interest.
- Also weigh the potential benefits of accepting awards from organizations sponsored by an entity with a vested interest in health care against our need for credibility.
- Weigh the potential conflict in accepting support from public, private, or foundation sources.
Butcher, Rosenthal win APEX Awards
Congratulations to AHCJ members Lola Butcher and Eric Rosenthal, who won APEX Awards for Publication Excellence for work that appeared in Oncology Times.
Butcher won in the category of “How-to Series Writing,” for her articles about Twitter and cancer care:
- “How Twitter Is Transforming the Cancer Care Community“
- “Oncologists Using Twitter to Advance Cancer Knowledge.”
Rosenthal was reconized in the News Series category for his “Economy Watch” series:
- As the Economy Turns, Cancer Centers Employ Watchful Waiting
- American Cancer Society Eliminates Exhibitions at Major Oncology Meetings
- Some of This Season’s Oncology Society Meetings May be Scaled Back
- Recessional Updates Reported from AACR’s Annual Meeting
More information about the awards and a complete list of winners is online (PDF).
Send us your latest news
Got a new job? Earned a promotion? Won an award or fellowship? Just published a book? AHCJ members are encouraged to share your news by sending it to info@healthjournalism.org. Member news items are posted on Covering Health and in HealthBeat, AHCJ’s newsletter.
Sapien chronicles formaldehyde battle
Filed under: Conflicts of interest, Government, Health policy, Hot Health Headline
At ProPublica, Joaquin Sapien tells the story of how Louisiana Republican Sen. David Vitter successfully obstructed the FDA’s attempts to get formaldehyde, which has been linked to leukemia, as a known carcinogen. Right now, it’s still listed as “probable.” The industry’s favorite tool, and the one Vitter employed for them in this case, was to force the EPA into conducting yet another costly, time-consuming study.
The EPA’s chemical risk assessments are crucial to protecting the public’s health because they are the government’s most comprehensive analysis of the dangers the chemicals present and are used as the scientific foundation for state and federal regulations. But it usually takes years or even decades to get an assessment done, or to revise one that is outdated. Often the industry spends millions on lobbying and on scientific studies that counter the government’s conclusions.
Sapien’s history of Sen. Vitter’s stonewalling, as well as his ties to the formadehyde industry, are an excellent example of just how difficult it has been for the EPA to upgrade key risk assessments.
Sapien’s story is well worth reading, but those looking for an overview can also refer to his excellent timeline, that goes from the EPA’s first health assessment in 1989 to Vitter’s demand that an assessment of the chemical be reviewed by the National Academy and his subsequent block of an EPA nomination late last year.
Researchers analyze media’s cancer reporting
Filed under: Health journalism, Hot Health Headline
University of Pennsylvania researchers reviewed 436 cancer-related newspaper and magazine stories (about 1/5 of the total) published between 2005 and 2007 and found that media tend to overhype aggressive treatments and avoid failures, errors, end of life care and death. Here’s the abstract in Archives of Internal Medicine.
In the press release, the study’s highlights are summarized thus:
- Although 32 percent of the articles focused on survival, only 8 percent covered death and dying; this despite the fact that half of all cancer patients will die of their illness.
- While most stories discussed aggressive cancer treatments, almost none (2 percent) discussed end-of-life, palliative or hospice care.
- 13 percent reported that aggressive cancer treatments can fail, and just 30 percent reported that aggressive treatments can result in adverse effects.
The authors note that the media under-reports palliative and hospice care, as well as outcomes data and other issues surrounding death and dying.
The study notes that unrealistic optimism is presented in most stories about cancer treatment, when in reality half of all cancer patients do not survive, according to statistics from the American Cancer Society.
“The nation’s leading media institutions have set a low bar for routine coverage of the nation’s long-running war on cancer. Hype is the norm,” wrote medical author Merrill Goozner, MS, in a commentary accompanying the article. “The relationship between journalism and medical researchers has been called a complicit collaboration in which both benefit from sensationalized stories. Recent media cutbacks and the evolution of a hyper speed news cycle only made things worse.”
“The tendency of the news to report on aggressive cancer treatments and survival, but not on alternatives, is … noteworthy given that unrealistic information may mislead the public about the trade-offs between attempts at heroic cures and hospice care,” the authors of the study wrote.
Roche linked to doctor praising drug in the media
Filed under: Conflicts of interest, Health journalism
Crikey.com, a news Web site based in Melbourne, Australia, calls our attention to some recent reporting about Mabthera, a drug used to treat non-Hodgkins lymphoma.
Nick Miller, health editor of The Age, recently reported that Mabthera, manufactured by Roche, “has been found to nearly double the number of [leukemia] patients who go into remission.”
In that article, Miller quoted a doctor as saying, “This is the largest single advance in the treatment of this disease in the last 30 years.”
Miller was rebuked by oncologist Dr. Ian Haines, who wrote a letter to the newspaper. Haines points out that the article was “an exaggeration of the benefits of the treatment with no presentation of the downsides … which is that it’s incredibly expensive, it’s not without risk,” according to Flint Duxfield, a student at the Australian Centre for Independent Journalism.
Duxfield goes on to explain how events unfolded and reveals that the promotion of Mabthera is being driven by Roche, which provides financial support to Peter MacCallum Cancer Centre, which employs the doctor who originally touted the drug in Miller’s article.
In fact, sections of the press release issued by the cancer center and the press release from Roche’s public relations company are identical and contain the same comments from the doctor quoted by Miller.
Duxfield also reports that warnings that have been issued for the use of Mabthera that have gone unreported in the print media.
The story says “the engagement of third parties in providing a link between a drug company and the media is all too common in health journalism.”
Veteran health reporter Ray Moynihan agrees: “It happens enormously often because third party endorsements are PR 101 for drug companies.”
Duxfield also points to other examples of these so-called “third=party endorsements” and how they have been reported in the media.
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New at HealthJournalism.org
- Data gives depth to investigation of patient safety
- What reporters should know about Alzheimer’s and related dementias
- Apply for fellowships to attend Health Journalism 2012
- AHCJ asks Supreme Court to permit broadcast of arguments in health reform case
- Tips for print, online journalists to embrace broadcast opportunities
- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
